KERARING ™ INSTRASTROMAL CORNEAL RING

HALTING THE DEBILITATING EFFECTS OF KERATOCONUS

What are corneal rings?

Corneal rings are curved pieces of perspex designed to be placed at a precise depth within the cornea. They were originally developed to treat myopia – the placement of a ring in the mid-periphery of the cornea causes flattening of the central part of the cornea.

There are two kinds of corneal ring available – Kerarings ™ and INTACs. Kerarings have been specifically designed to treat keratoconus and we’ve found them very safe and effective. We no longer use INTACs.

Apart from keratoconus, Kerarings ™ also treat

Pellucid marginal degeneration

Post-LASIK ectasia

Who do Kerarings ™ help?

Kerarings ™ are particularly beneficial for treating mild to moderate keratoconus. Research we conducted at Leeds Teaching Hospitals demonstrated that 95% of patients with mild to moderate keratoconus benefitted from Keraring ™ implantation.

The results were less predictable for advanced keratoconus but still worth considering in patients who would otherwise need a corneal transplant to restore vision.

How do you treat keratoconus?

James Ball explains the different treatment options for treating keratoconus, including corneal cross-linking, intrastromal corneal rings and how he’d like to make corneal transplants for keratoconus no longer needed.

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LIFE IS IN THE DETAILS

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How do Kerarings ™ work?

The short answer is that no one is entirely sure.

Based on our studies we think that the following mechanism is the most important. The Keraring ™ seems to be most effective when it is able to bridge from stronger cornea through the cone to stronger cornea on the other side. A bit like an RSJ (rolled steel joint) used in building. The ring pulls the cone back in line with the rest of the cornea and lifts the steepest part of cornea onto the visual axis. This means that the part of the cornea which the patient is looking through is more regular and is able to give them better vision.

Advantages and disadvantages of Kerarings ™?

Advantages

Keraring ™ is a rapid and painless treatment. We use a femtosecond laser to make a precise tunnel in the cornea. This takes just 8 seconds. We then slide the Keraring ™ segment(s) into the tunnel. This takes a couple of minutes. The whole procedure usually takes just five minutes.

Keraring ™ has a rapid recovery. The eye may be a little sore and scratchy the evening of the treatment but settles very quickly. Any improvement in vision is usually evident within a few days but may take up to three months.

Keraring ™ is reversible. If the Keraring ™ does not provide any improvement it can easily be removed and the cornea returns to its previous state.

Disadvantages

Keraring ™ has less predictable results for advanced keratoconus. Some patients experience a mild glare effect from the Keraring ™ in certain light conditions, although this settles over time.

Options and alternatives to Kerarings ™

Spectacles and contact lenses can work well for mild to moderate keratoconus.

Keraring ™ implantation does not prevent progression of keratoconus. In many patients, the keratoconus stabilises with natural age-related cross-linking but many patients, particularly younger patients may require C3-R cross-linking treatment.

Further information about Keraring ™ treatment

At the preliminary Examination

A preliminary examination and measurement of your eyes is performed. This examination lasts about two hours.
Before this preliminary examination you should not have worn soft contact lenses for one week, and hard contact lenses for two weeks.

On the Day of Your Keraring ™ Treatment

We recommend that you wear comfortable clothes on the day of treatment. You can eat and drink normally on the treatment day, but please do not smoke. For hygiene reasons, it is important that you wash your face thoroughly prior to treatment, completely remove makeup, and avoid perfume.

You will be given anaesthetic eye drops to numb the surface of the eye, and you should feel no discomfort during the procedure. The surgery will be carried out as an outpatient procedure. Sunglasses are recommended after the procedure.

The total duration of the surgery (one eye) lasts approximately 10-15 minutes.

You are not allowed to drive a vehicle after the procedure.

The Keraring ™ Procedure – Step by Step

First, a tunnel is prepared in the cornea for the ring to be inserted into. At St James, we use the femtosecond laser – which makes the precise incision within 16 seconds.

The ring is inserted into the tunnel, and carefully positioned. The rings “tighten” the corneal cone and creates a more regular corneal surface.

After the Keraring ™ Surgery

The eye can be a little red – please do not rub your eyes. Eye drops will be given that prevent swelling and inflammation. The use of the eye drops will be discussed with you before you leave.

You can return to work after 2 days, resume sports activities after approximately 3 days, swimming and sauna after approximately 2 weeks.

You will receive a post-operative follow-up examination after 1 day, 1 week and 1 month.

You may drive a vehicle again only with the doctor’s permission, normally after the first post-operative examination.

Frequently asked questions about Keraring ™

A Keraring ™ is an artificial ring, which consists of two semicircular segments 5mm in diameter and of variable thickness. The ring is made out of artificial material, Perspex CQ Acrylic, which is the same material used for more than 20 years for artificial lens implants in cataract and refractive lens exchange surgery. The Keraring ™ is tolerated well by the cornea and no risk of rejection exists. The main reason for the surgery is an improvement in vision. Kerarings can halt the progression of keratoconus and prevent the need for a corneal transplant. Once the Keraring is in place a crosslinking procedure can be performed to stabilise the cornea, usually 2 to 3 months later.

First, the centre of the cornea is marked, then a tunnel is prepared using the femtosecond laser. The femtosecond laser places the incisions very precisely in 16 seconds. The rings are inserted into the tunnel.

Haloes around lights may be seen in the vision after the Keraring ™ implant. These improve with time, and it is unusual for this to cause significant problems with the vision.

In some patients, the Keraring ™ may improve the contour of the cornea, but not produce a significant improvement in the quality of vision even with a change of glasses or contact lenses.

The risk of a serious complication causing visual loss, such as an infection, is less than 1 in 1000. Complications are generally not severe, but if they do occur, the Kerarings ™ may need to be removed.

Despite Keraring ™ surgery, a corneal transplant may still be necessary in some cases.

Results at a glance

0

Laser procedures

0

Cataract procedures

0%

Better than the national average of complication rates

My eyesight following the operation is brilliant and better than I thought possible, and this is all down to your excellent surgeon Mr James Ball and not to forget all the very dedicated people around him who make these operations possible.

Keith Garlick

Two of the best decisions I ever made in my life were firstly to have lens exchange and secondly to have Mr James Ball carry out my operation.

Patricia Walton

Within minutes I could tell there was a difference. But now, only a couple of months later, my sight is better than it was seven years ago! I can even read the really tiny print on the car sales ads! If you want that confidence you probably felt when you were younger, this is the ideal solution. Thanks to the treatment, I feel rejuvenated, independent and much younger!

John Hazelgrave

Many thanks for all your care and kindness. To me it appears a miracle that I can see so well. I feel very grateful. It is impossible to fully express my thanks.

Grace C.

May I offer grateful thanks for your expertise in operating on my eyes. It was intimated to me that you were the best, and from the results I am now enjoying, I am convinced that this is correct.

Jean D.

You are truly innovative. Thank you very much for curing the problems I have been having with my reading and near vision.

Sala M.

My work was becoming almost impossible. I had refractive lens exchange to both eyes with multifocal lens implants last July. I can now see better than 20/20 for distance and can read the tiniest print in newspapers - all without glasses! I have started reading for pleasure again, and I feel that my performance both at work and on the golf course has improved.

Request a callback

Name

Phone*

Email*

Comments (optional)

Privacy*

I consent to receive valuable and relevant information via telephone and e-mail (some of which are about Custom Vision Clinic’s services). We will process your data in accordance with our Privacy Policy. I can withdraw my consent at any time by unsubscribing from any e-mail I receive.

Name

This field is for validation purposes and should be left unchanged.

My eyesight following the operation is brilliant and better than I thought possible, and this is all down to your excellent surgeon Mr James Ball and not to forget all the very dedicated people around him who make these operations possible.

Keith Garlick

Two of the best decisions I ever made in my life were firstly to have lens exchange and secondly to have Mr James Ball carry out my operation.

Patricia Walton

Within minutes I could tell there was a difference. But now, only a couple of months later, my sight is better than it was seven years ago! I can even read the really tiny print on the car sales ads! If you want that confidence you probably felt when you were younger, this is the ideal solution. Thanks to the treatment, I feel rejuvenated, independent and much younger!

John Hazelgrave

My work was becoming almost impossible. I had refractive lens exchange to both eyes with multifocal lens implants last July. I can now see better than 20/20 for distance and can read the tiniest print in newspapers – all without glasses! I have started reading for pleasure again, and I feel that my performance both at work and on the golf course has improved.

John

Laser eye surgery has changed my life. Now, having had laser, I wake up in the morning and I can see and it’s unbelievable.

Claire Varley

Laser eye surgery has greatly improved my quality of life. I’ve been able to discard my glasses after thirty years!

Arthur Brown

If you are thinking of having Laser Eye Surgery, try these guys – they really are the best in their field.

Mr CE Poulter

I felt I was treated as an individual and all my questions were answered. From my experiences – I can highly recommend Mr Ball.

Janet Howden

Wonderful, Wonderful, Wonderful! I am so grateful to you and your team. Thank you very much indeed.

Dorothy S.

Thank you for your skilled interventions which have given me my sight back.

Doreen G.

To me it appears a miracle that I can see so well. I feel very grateful. It is impossible to fully express my thanks.

Grace C.

Thank you very much for the treatment you gave me – I can see so well now, and reading has once again become a real pleasure.

Charles S.

It was intimated to me that you were the best, and from the results I am now enjoying, I am convinced that this is correct.

Jean D.

You are truly innovative. Thank you very much for curing the problems I have been having with my reading and near vision.

Sala M.

I had LASIK on both eyes at Custom Vision Clinics, and can now see better than 20/20, without my glasses or contact lenses. More importantly, I now feel that I can get more out of my busy life.

Karen

At the consultation, Mr Ball found that I had early cataracts. Following cataract surgery at Custom Vision Clinics, I am almost completely independent from glasses.

DISCOVER YOUR EYE TREATMENT OPTIONS

Request a Call Back

Name

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Comments (optional)

Privacy*

I consent to receive valuable and relevant information via telephone and e-mail (some of which are about Custom Vision Clinic’s services). We will process your data in accordance with our Privacy Policy. I can withdraw my consent at any time by unsubscribing from any e-mail I receive.

Fight for Sight is the eye charity leading the way in pioneering sight loss research. This is a link to their page on keratoconus.

About the author

Mr James Ball | Consultant Ophthalmic Surgeon

MA (Cantab) MB BChir FRCOphth CertLRS

I am a Consultant Ophthalmic Surgeon at Custom Vision Clinic, St James’s University Hospital, and Nuffield Hospital. My major interest is in refractive surgery and finding the best treatment suitable for each patient.

LIFE IS IN THE DETAILS

Maintaining excellent vision is critically important to a good life. In your twenties or thirties you might get fed up with the need for glasses and contact lenses. After 45, we all wind up needing reading glasses which can be frustrating and feel like premature ageing. Starting as young as 50, cataracts can begin to cloud up our vision. Each life stage demands a unique eye treatment plan.

WORLDCLASS IN YORKSHIRE

Many people think that the most customised eye surgery is only available in London - but that is no longer true. After working for years in London, Mr James Ball decided to open the doors to a brand new world class facility here in Yorkshire. The clinic offers innovative eye treatment options to 3 unique age ranges: people under 40, those ages 40 to 60 and people over 60.